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XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.
Year 2015 Vol. 23 No 1
GENERAL AND SPECIAL SURGERY
R.E. KALININ, A.S. PSHENNIKOV, I.A. SUCHKOV
REALIZATION OF ISCHEMIA AND REPERFUSION IN SURGERY OF MAJOR ARTERIES OF THE LOWER LIMBS
SBEE HPE "Ryazan State Medical University named after academician I.P. Pavlov",
The Russian Federation
Objectives. To study the molecular mechanisms of endogenic angioprotectors of stress-limiting system NO-heat shock proteins HSP70 and vascular endothelial growth factor system (VEGF) as a long-term adaptation variant to ischemia in lower limb reconstructive surgery.
Methods. According to the design the study is considered to be an open, prospective, in parallel groups, includes 40 patients with the obliterating lower limb atherosclerosis. The patients were divided into 4 groups according to the degree of the lower limb ischemia and the methods of operation: the 1st group – 10 patients according to Fontaine classification system (IIb-III stages) and the 2nd group – 10 patients (IV stage) who had undergone reconstructive surgery with polytetrafluroethylene graft (PTFE); the 3rd group – 10 patients with cardiogenic nonvalvular embolism of lower extremity arteries undergone urgent embolectomy; group 4 – 10 patients (IIb stage) without arterial reconstruction due to poor distal runoff or patient’s refusal to be operated on.
Results. In ischemia/reperfusion realization HSP70 dynamics was comparable in all patients undergone arterial reconstruction, i.e. stress reaction to damage was similar regardless of the extent of ischemia. Increased secretion of the studied metabolites may be regarded as a protective mechanism to ischemic/reperfusion injury. Increased secretion of the studied metabolites is considered as a kind of defense mechanism in the implementation of ischemia/repersusion and their reduction in the postoperative period is largely due to the degree of circulatory compensation. Intraoperative endothelial injury deteriorated the course of the endothelial dysfunction by activating NO synthesis.
Conclusion. Stress-inducible NO and HSP70 systems combined with endothelial growth factor form a kind of “shield” which timely limits the impact of the damaging ischemic/reperfusion factors.
- Klinicheskaia angiologiia [Clinical angiology]: rukovodstvo: v 2-kh t. / pod red AV. Pokrovskogo. Moscow, RF: Meditsina; 2004. 888 p.
- Natsional'nym rekomendatsiiam po vedeniiu patsientov s zabolevaniiami arterii nizhnikh konechnostei [The national guidelines for the management of patients with arterial diseases of the lower extremities]. Moscow, RF: 2013;19(2):67.
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA. Trans-Atlantic Inter-Society Consensus. Eur J Vasc Endovasc Surg. 2007;33(l Suppl 1):S1-S75.
- Carden DL, Granger DN. Pathophysiology of ischaemia-reperfusion injury. J Pathol. 2000 Feb;190(3):255-66.
- Granger DN. Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol. 1988 Dec;255(6 Pt 2):H1269-75.
- Alcocer F, Whitley D, Salazar J, Jordan W, Bland KI.Mutual exclusion of apoptosis and hsp70 in human vein intimal hyperplasia in vitro. J Surg Res. 2001 Mar; 96(1):75-80.
- Fraisl P, Mazzone M, Schmidt T, Carmeliet P. Regulation of angiogenesis by oxygen and metabolism. Dev Cell. 2009 Feb;16(2):167-79.
- Zhang Y, Yang H, Barnie PA, Yang P, Su Z, Chen J, Jiao Z, Lu L, Wang S, Xu H.The expression of Toll-like receptor 8 and its relationship with VEGF and Bcl-2 in cervical cancer. Int J Med Sci. 2014 Apr 16;11(6):608-13.
- Kirichuk VF, Glybochko PV, Ponomareva AI. Disfunktsiia endoteliia [Endothelial dysfunction]. Saratov, RF: Izd-vo Saratov med un-ta. 2008. 129 p.
- Kalinin RE, Zviagina VI, Pshennikov AS, Suchkov IA, Matveeva IV. Fotokolorimetricheskii metod opredeleniia urovnia metabolitov oksida azota v syvorotke krovi [Photocolorimetric method of determining the level of nitric oxide in serum]. Astrakh Med Zhurn. 2010;5(1):88-89.
- Pal'tsev MA, Ivanov AA, Severin SE. Mezhkletochnye vzaimodeistviia [Intercellular interactions]. Moscow, RF: Meditsina. 2003. 288 p.
390048, Rossiyskaya Federatsiya,
g. Ryazan, ul. Stroykova, d. 96,
GBOU VPO "Ryazanskiy gosudarstvennyiy
meditsinskiy universitet imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel. mob: 7 910 900-95-23,
Pshennikov Aleksandr Sergeevich
Kalinin R.E. MD, professor, a head of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Pshennikov A.S. PhD, an assistant of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Suchkov I.A. MD, an associate professor of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".